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目的探讨华法林预防非瓣膜性心房颤动(NVAF)患者发生脑卒中的疗效和安全性。方法选择慈溪市人民医院和市第二、第三人民医院门诊和住院治疗的非瓣膜性房颤患者136例,随机分为调整剂量华法林组(初始剂量2 mg/d),目标国际标准化比值(INR)为2.0~3.0,阿司匹林组(100 mg/d)和对照组(未用抗栓药物)。常规门诊随访,调整华法林剂量并记录三组患者的终点事件和不良反应发生情况。结果136例患者,失访4例,随访男性77例,占58.3%,平均年龄70.6岁。华法林组40例,平均用量为(2.5±1.0)mg;阿司匹林组42例,对照组50例。三组患者基本特征(包括合并疾病和伴随用药)比较差异无统计学意义(P>0.05)。有≥3项伴随危险因素的病人,三组之间总体生存函数差异有统计学意义,P<0.05,华法林组生存率明显高。结论有≥3项伴随危险因素的NVAF患者,华法林可改善患者的生存率,华法林组多数出血并发症发生在INR>3.0。严密监测(INR 2.0~3.0)下的调整剂量华法林安全有效。
Objective To investigate the efficacy and safety of warfarin in the prevention of stroke in patients with nonvalvular atrial fibrillation (NVAF). Methods One hundred and sixty-six patients with non-valvular atrial fibrillation in Cixi People’s Hospital and the Second and Third People’s Hospital of Cixi were randomly divided into adjusted-dose warfarin group (initial dose of 2 mg / d), target international standardization The odds ratio (INR) ranged from 2.0 to 3.0, to aspirin (100 mg / d) and to the control group (no antithrombotic drugs). Regular outpatient follow-up, adjusting warfarin dose and record the end point of three groups of patients and adverse reactions. Results 136 cases of patients, 4 cases were lost to follow-up, 77 were male, accounting for 58.3% with an average age of 70.6 years. Warfarin group 40 cases, the average dosage was (2.5 ± 1.0) mg; aspirin group 42 cases, control group 50 cases. The three groups of patients with basic characteristics (including the combined disease and concomitant medication) was no significant difference (P> 0.05). There were more than 3 patients with risk factors, the overall survival function between the three groups was statistically significant, P <0.05, warfarin survival was significantly higher. CONCLUSIONS: With ≥3 NVAF patients with risk factors, warfarin improves patient survival, with most bleeding complications in warfarin occurring at INR> 3.0. Warfarin (INR 2.0 ~ 3.0) under the adjusted dose warfarin safe and effective.